Foreskin Surface Area and HIV Acquisition: Size Matters

Randomized clinical trials conducted by researchers in Rakai, Uganda, have revealed a link between the size of foreskin surface area and the risk of male HIV acquisition. The results of the trials have been published in the current issue of AIDS, the leading journal in the field of HIV and AIDS research. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, and pharmacy.

In recent years, several studies have shown that circumcision reduces the risk of male HIV acquisition by 50-60%, and circumcision is now recommended by WHO/United Nations Joint Programme on HIV/AIDS (UNAIDS) as an HIV prevention strategy. Based on this evidence that the foreskin increases vulnerability to HIV, Dr Godfrey Kigozi and his colleagues hypothesized that the size of the foreskin might be related to the risk of HIV infection.

Eligible candidates for this retrospective cohort study were drawn from the initially HIV-negative participants in the Rakai Community Cohort Study. These men were subsequently enrolled into the randomized trials of male circumcision and had measurement of their foreskin surface area taken following surgery. The researchers then determined HIV acquisition in these men and assessed the association between foreskin size measured after surgery, and the incidence of HIV acquisition while under surveillance prior to circumcision. Their results determined that the risk of male HIV acquisition was significantly increased in men with larger foreskin surface areas.

The researchers point out that their study is unique and their findings therefore need to be replicated. However, these results, in addition to the observational studies and randomized trials, add plausibility to the hypothesis that the foreskin is a tissue vulnerable to HIV acquisition.